Nevada Pharm Law Flashcards
1
Q
What does the practice of pharmacy include
A
- Performance or supervision of activities associated with manufacturing, compounding, labeling, dispensing etc, and handling pt info
- Interpretation and evaluation of rx or med orders
- Preparation in drug evaluation and research
- Advising therapeutic value, reaction, drug interaction, hazards of drug use
- Selection of the source, storage, distribution of a drug
- Maintenance of proper documents
- Interpret clinical data contained in a persons record
2
Q
What is a pharmacists job when it comes to collaborative drug therapy management?
A
Development of written guidelines and protocols with a practitioner to authorize a pharmacist to order and use the finder of lab tests and examinations
3
Q
What is the role of a pharmacist when it comes to implementation and modification of drug therapy?
A
Administering drugs and ordering and pro forming tests in accordance with collaborative practice agreement
4
Q
Where can a registered pharmacist engage in the practice of pharmacy?
A
ONLY in the state of a licensed pharmacy
5
Q
What does a pharmacist need to do so they can engage in the practice of pharmacy at a site other than the site of a licensed pharmacy
A
They must apply with the board of pharmacy to do this
6
Q
What is collaborative drug therapy management
A
Means initiating, monitoring, modifying or discontinuing a patients therapy by one of more pharmacists under supervision of one or more practitioners in accordance with a collaborative practice agreement
7
Q
What is the collaborative practice agreement?
A
Agreement between one or more pharmacists and one of more practitioners to authorize a pharmacist to engage in collaborative practice of pharmacy or collaborative drug therapy
8
Q
What is collaborative practice of pharmacy?
A
Means performance of tests to address things such as chronic diseases, or public health issues by one or more pharmacists in collaboration with one or more practitioners
9
Q
What is drug therapy by a pharmacist?
A
Written guidelines and protocols developed by a registered pharmacist in collaboration with a practitioner which authorizes collaborative drug management
- RPh can order lab tests
- RPh can provide feedback on meds they are taking or should be changed (within 72 hours)
10
Q
Can an intern or pharmacist perform blood glucose testing?
A
Yes, as long as the device being used is approved for use at home
11
Q
What does the state board of pharmacy members consist of?
A
7 members appointed by the governor
- 6 members are registered pharmacist in state of Nevada, with a least 5 years experience
- One member from the general public
- Appointed for 3 year term and cannot serve more than 3 consecutive terms
12
Q
What does an applicant need to become a registered pharmacist?
A
- Be of good moral character
- Graduate of accredited pharmacist school
- Pass MPJE (multi state pharmacy jurisprudence exam)
- Complete not less than 1740 intern hours
App is good for 1 year once received by state board
13
Q
What is a temporary license for a pharmacist?
A
Can have one for up to 6 months, if qualify and allows them to work in the state
If moving from somewhere else the temp allow them to work while board makes sure they can practice in new state
14
Q
What is inactive status on a pharmacist license?
A
- Must certify the RPh is not engaging in the practice of pharmacy in the state
- Will not be engaging in the practice of pharmacy in the state while inactive
15
Q
What must a RPh follow is their license is out inactive?
A
- May not engage in the practice of Pharamacy in state
- Must renew certificate of registration biennially
- Not required to do CEs
- May apply to board to have it returned to active
16
Q
What does an RPh need to do in order to become active status again?
A
- Submit application with board
- Show evidence of active license in another state or
- Completed 30 units CE, within 2 years or filing application to renew
- Passed written CE exam on law
If for medical reasons you must prove you are physically capable to come back to work
17
Q
What is a certificate after forfeiture?
A
If the RPh did not renew their license the board may, within 5 years thereafter, issue a certificate of registration to the person if they determine
- Person hasn’t committed any crimes and paid the fee
- Is capable and qualified by education or experience
18
Q
What can a pharmacist do if their licensure is revocation
A
- May petition the board for reinstatement after a period of not less than 1 year since it happened
- Board will have a meeting not eailer than 39 days after the petition is filed. Will have majority vote to find that the public interest would be best if reinstated or not
19
Q
What happens when there is a suspension of licensure?
A
After time of suspension is over the license is automatically restored to good standing the first day following suspension period.
* board must inform respondent if the date they will be restored
20
Q
What can a pharmacist do if their license is suspended due to incompetency
A
- May petition the board for reinstatement
- The board will conduct a hearing to determine to reinstate
- Board will rule; may require a vote or the person to pass an exam, either oral or written to present fitness to resume
- May use an expert witness to help determine action
21
Q
What happens if a pharmacist voluntary surrenders their license?
A
The board will initiate proceedings to revoke the registration for the pharmacy to practice in the state of Nevada
22
Q
What needs to be displayed for a pharmacist, intern, or tech?
A
Each listener, permit, or certificate must be displayed where it can be clearly seen by the public
* if you work at more than one place a copy of the license must be posted at each site the pharmacist, intern, tech works
23
Q
What happens if a pharmacist, intern, or tech Chang’s his or her residence or place of practice ?
A
Must within 10 days after changing give written notice of change to the executive secretary of the state board
24
Q
When does a pharmacist certificate expire?
A
Expires October 31st if each odd-numbered years
25
When does a pharm intern or tech certificate expire?
On October 31st if each even-numbered years
26
How often must certificates, licensed and permits be renewed?
Biennially (every 2 years)
27
What must an application contain to get a licensure of running a pharmacy?
Must submit forms to the board that state the name, address, usual occupation and professional qualifications of the applicant
* if more that one person you must name them all
28
When will the board not give a license to run a pharmacy?
1. Will not give to any practitioner; or to any partnership, corporation or association in which a practitioner has a controlling interest or owns more than 10% if available stock
2. It doesn’t apply to: a hospital pharmacy, ownership by a practitioner of a building in which the pharmacy is located as log as they are charged correct rate for rent
29
What’s important to know about internet pharmacies?
An internet pharmacy may practice only if certified by the board
1. They are certified by the verified internet pharmacy practice sites program of the national association of boards of pharmacy or
2. Board determines that the pharmacy satisfies the requirements established
30
What must an applicant for registration as a pharm tech have?
1. Be 18 or older
2. High school or higher grad
3. Not convicted of felony or misdemeanor relating to drugs
4. No history of drug abuse
31
What must a tech complete in order to be a tech in the state of Nevada ?
1. Pharm tech school
2. Hold another state license with equivalent requirements as NV and work for at least 240 hours in that state
3. Complete 1500 hours of pharm tech training (with tech in training licenses)
4. Complete program with Army, veterans affairs or Indian health services
5. Pharm tech certificate board proof
32
What are the duties of a pharm tech?
Under supervision of pharmacist
1. Prepackage and label unit dose and unit is (RPh must check off work)
2. Prepare, package, compound and label RX on ye order of a prescription (RPh must check off)
3. Prepaid bulk compounds (RPh must inspect)
4. Distribute routine orders, stock meds
5. Maintain inventories of supplies
6. Maintain pharm records
7. Request refills on meds already written
8. Transfer rx: ONLY IF THRO SAME COMPANY SYSTEM
9. Enter info into computer about rx
33
What are pharm techs not allowed to do in pharmacy?
1. Preform any action that requires a judgment decision regarding a drug, interpretation of a prescription or the instructions for the preparation of a prescription
2. Take a new prescription or chat order by phone
3. Distribute meds on a chart order or dispense a rx unless the chart order or rx has been verified by an RPh
34
In a hospital setting what are the tech supervision restrictions?
1. RPh who is dispensing may not supervise more than 3 tech at a time
2. The RPh who is supervising distributive functions may not supervise more than two techs and one tech in training at a time
35
What are the technician supervision restrictions in a pharmacy?
RPh may not supervise more than 3 techs or one tech and 2 tech in training at a time
36
A RPh may supervise more than 3 techs or techs in training if:
1. Not more than 3 techs or techs in training are performing the duties of a tech; and
2. Pharmacy maintains a record and identifies which techs and techs in training are performing tech duties
37
Who is ultimately responsible for any thing the pharm tech does?
The RPh
| 1. anything done by pharm tech must have the initials of the tech as well as the supervising rph
38
If a tech performs any of the functions in prepared a prescription the rph is responsible for what?
everything but some specifics
1. selection and strength of drug
2. dosage form
3. labeling the rx
39
Tech in-service training. what is the owner of pharm manger responsible for
providing in-service training to their technicians to ensure competency of technicians
1. must give initial training upon employment;
2. at least 12 hours of in-service training during 2-year period preceding renewal of registration
* managing rph must maintain a written record of initial training and the annual training completed
40
What is an Intern Pharmacist
Any person who is not a registered pharmacist, but who is fulfilling the requirements to become eligible for registration as a pharmacist, shall register with the Board as an intern pharmacist
* must be enrolled in a college of pharmacy approved by the board
41
Who is able to be a preceptor to an intern pharmacist
Any registered pharmacist may do so
42
What does the college of pharmacy which the intern attends need to establish for the intern
1. scope of duties
2. scope of duties must be provided before the internship begins
* must be based off the courses the intern has completed; the intern will inform the preceptor of what they are responsible for
43
What are the duties an intern pharm can do it the state of nevada?
1. selling of CS,
2. Compounding of rx drugs
3. filling of RX and dispensing of RX
4. prepairing and maintaining such records and reports required by law
5. counseling pts about RX
6. the practice of pharmacy
7. administering immunizations with a written protocol established by a physician
44
What duties should a preceptor not allow an intern pharm do?
1. anything outside the scope of duties established for the intern by the college
2. use professional judgement to know what they student shouldnt do
45
What must a preceptor do for the intern?
1. document the number of horus worked
2. maintain that documentation
3. provide a copy of that info to
* the college, to the intern if they have graduated
46
What happens if the preceptor or the intern quits
They must inform the school and must state the reasons why there is termination of the internship
47
What are the requirements for a PA to be able to prescribe CS in Nevada
1. must submit an application
2. pass exam issued by board of pharmacy law
3. Have a copy from board of medical examiners
4. must have a registration certificate issued by a registered to a supervising physician
48
How long does a PA have to to notify the board of a change of address or place of work?
10 days
49
Can a pharmacist or an intern give immunizations?
Yes, by intranasal, IM, or subcu as long as its in compliance with a written protocol from a physician
*rph can not delegate this authority unless to an intern who is supervised
50
What must be done in order for a pharmacist or intern to be able to give shots?
Must be trained and certified by completeing a course.
| * min of 20 hours of instruction and practical
51
What must an intern of pharmacist who administers immunization have?
1. maintain BLS card from AHA
2. on or before October 31 of each year, complete
* At least 2 hours of CE that address the life cycle of diseases, drugs and administration of immunizations; or course by CDC about epidemiology and prevention of diseases
52
Where are immunizations reported?
In the immunization info system established by department of health and human services (WebIZ)
*must keep records for two years
53
What must the immunization protocols contain
1. name of physician auth the shots for pharmacist
2. list of immun pharm can give
3. detailed policies and procedures the pharm must follow (hazard waste, needle sticks. etc)
4. A procedure to review the protocols at least once a year
5. instructions related to pt age
6. Restriction that only an RPh can give the shot (intern ok)
7. Restriction that it can only be given at a specific location (not in pt home, LTC can be ok)
8. requirement that all fed laws will be followed
9. signature of physician
54
How many CEs must a pharmacist complete
must complete 30 CE units within the biennium immediately preceding the current renewal period
55
How can an RPh earn a CE unit?
1. Attended a meeting approved by the board
2. attending an entire day of any meeting of the board
* *can not carry over excess CE units earned
56
What makes Pharmacists excused from full compliance of the CE requirements
1. exempt for 2 years after receipt of a degree in pharmacy
2. applicant who is residing and practicing outside of this State is exempt from the requirement of one continuing education unit in a jurisprudence program
57
How long must an RPh retain the certificate of completion for a CE?
For 4 years following the completion of the course
| * must be able to present it upon request from the state board
58
How long does each record need to kept in the phamracy
At least 2 years after the date of the record
*they must be made available for inspection and copying upon request of the board, or another authorized local, state or federal law enforcement agency
59
What must a pharmacy maintain when it comes to C2 inventory
They must keep perpetual inventory
60
What records must the pharmacy keep and maintain?
1. copy 3 of DEA form 222,
2. suppliers' invloices of controlled substances and dangerous drugs
3. suppliers' credit memos for CS
4. biennial inventory of CS required by DEA
5. any reports of theft or significant loss of CS
6. reports of the surrender or destruction of CS
7. Register book for nonprescription drugs listed in C5
61
If a pharmacy dispenses controls in C3-5 to another pharmacy what invoices do they need to keep>
1. actual date of distribution
2. the name, strength and qty of CS
3. the distributing pharmacy's name, address and DEA $
4. The name, address and DEA # of the pharmacy or practitioner to who the CS was distributed
62
If a pharmacy distributes controlled substances listed in C1-2 what must the pharmacy maintain?
1. main a copy 1 of DEA 222 form, *it must show the qty of CS distributed and the actual date of distribution
63
What must a pharmacy keep on file in terms of the current statutes, regulations and reference material
1. Must keep at all times copies of all current state statutes and regulations relating to the practice of pharmacy and sale of CS
2. must maintain reference mats in the form of the lastest editions of pharmaceutical texts (can be on computer program or disc)
64
Each licensed pharmacy must maintain in the prescription department the latest editions of texts (online) of what texts?
1. preparation and compounding of rx
2. biological and therapeutical equivalencies of drugs
3. pharmacology and pharmacokinetics
4. indications and usage of drugs
5. contraindications of; adverse reactions to and warnings about drugs
6. dosage and administration of drugs
7. overdosages of drugs
65
What security is there for the prescription department of every pharmacy?
1. must be separated from merchandising or public areas with a barrier not less than 5 feet aboe the floor
2. barrier must be of solid material and contain one gate or door
3. door or gate must be secured by a dead-bolt lock that can be opned from the outside only by key
4. door or gate may be secured by combination lock during business hours
66
What must the RPh on duty do in terms of security?
1. maintain possession of the key to the prescription department *key can only be accessible to a licensed pharmacist within pharm department
2. responsible for securing the rx department at all times
67
What are some important things to remember about the security of the pharmacy
1. on person other than RPh may enter the pharmacy unless he or she is on business directly concerning the operation, maintenacne or repair of the rx department and RPh is physically present
2. Pharmacy must have an alarm system that is operational 24 hours a day and is monitored by central station
3. a pharmacy in a hospital or correctional institution and any pharmacy that is staffed 24 hours a day exempt from 5
68
What should you know about the physical address for delivery of drugs to a pharmacy?
1. a pharmacy which purchases drugs must have the drugs shipped to the pharmacy address and physically received at the pharmacy
2. drugs purchased by a pharmacy must NOT be drop-shipped to any other address
3. Pharmacist must acknowledge on every invoice that drugs listed in invoice were physically received
69
What must drive-thru pharmacies ensure?
1. The pharmacy is secure and doesnt allow unlawful access
2. readily accessible to pharm personnel
3. provide two-way visual and auditory communication
4. be equipped with a comp terminal that is a part of pharm comp system
5. be equipped to provide pt counseling without losing visual or auditory communication with the pt
70
Who and when should be informed if a notice of employment and termination of employment happens
If a RPh, intern, tech or tech in training has this happen you must infrom the Executive Secretary of the board within 10 days of it happening
71
What must each person employed by the pharmacy wear?
Each person must wear identification that clearly identifies the person by name and classification of his or her registration
72
Can a closed pharmacy for a meal break take in a new RX?
Yes, as long as it is placed in secure container and can not be seen, removed or damaged until it is retrieved
2. an authorized employee of the pharmacy personally accepts and secures the rx from the pt outside the closed and secured premises of the pharmacy
73
Does the state board regulate the sale of prescription and nonprescripton vet drugs?
Yes they do
74
what are the restrictions on the use of rabies vaccine?
rabies vaccine for vet use only,
75
What does a pharmacy outside of Nevada need to follow if they mailorder drugs into Nevada
1. May sub a drug if the sub is allowed within the laws and regs of the state
2. shall provide toll-free phone number so pts can access a pharmacist who has access to pts records. *must be open not less than 5 days a per week for at least 40 hours a week, also must be on the label
76
How often should a pharmacist be available from any pharmacy furnishing parenteral solutions?
Must be available 24 hours a day for consultation with the pt and the pts primary provider of care
77
Can a practitioner dispense a CS if they change a pt for the substance with charges for other professional services?
NO, only is they first apply fro an obtain a certificate from the board and pays the required fee and issues a written rx
78
What is the PMP?
the patient utilization report. tells the person looking a report from the last 12 months if the PT got any CS
79
what does a practitioner need to do before they write CS for a pt?
They must check the PMP if the pt is new or the pt has not received any rx for a CS from the practitioner in the preceding 12 months
80
How does the NV PMP work
Healthcare providers access the NV PMP through a secure, web-based application to request patient prescription history reports. The website is available 24 hours a day, 365 days a year
81
Who is allowed to access NV PMP
Healthcare providers authorized to prescribe or dispense controlled substances including, physicians, dentists, advanced practitioners of nursing, physician assistants and pharmacists are eligible to register for direct on-line access to the NV PMP
82
who is allowed to write an RX in the state of Nevada?
A practitioner holding a license in Nevada
| person who is licensed to practice in another state and is authorized to prescribe
83
Can an RPh fill a C2 for a pt if the practitioner is not licensed in the state of Nevada?
Yes, the RPh must establish and document that the rx is authentic and that an real relationship between the pt and prescriber existed when the rx was written
84
Can an RPh fill a C3-5 for a pt if the practitioner is not licensed in the state of Nevada?
Yes, the RPh needs to make sure the rx is authentic and a relationship between the pt and prescriber existed when the rx was written. Doesnt need to be done on any subsequent rx brought in
85
What must a written rx contain?
1. the name and signature of practitioner (unless orally given) *and address if not RA to RPh
2. classification of the practitioners license
3. name of pt, their address if not RA
4. name, strength and qty of drug
5. symptom or purpose for which the drug is prescribed, if included
6. sig codes
7. date of issue
86
What must be specific about the sig codes when it comes to being written
Must indicate the portion of the body to which the med is to be applied or, if take be taken into the body by other means.
ex: by mouth, rectal, topcial
87
what must happen to make an electronic transmission of an rx not to require the signature of the practitioner?
1. contains facsimile sig, security code or other mark
| 2. voice recognition system, biometric ID technique or other security system approved by board
88
What must be on the label of an RX?
1. the date
2. name, address and prescription serial number of the practitioner who filled the rx
3. names of the prescribing practitioner and the person for whom prescribed
4. number of dosage units
5. specific directions
6. expiration date of the drug and medicine dispensed
7. proprietary of generic name of the drug
9. the strength of the drug
89
A pharmacy may not refill a rx unless:
1. the pt, pts practitioner, or pt agent has requested a refill of the rx and the rx has refills remaining
2. the physician has authorized additional refills on the rx without remaining refills
90
Can an RPh give out a 90 day supply for a med, other than a controlled substance if the pt was prescribed less than a 90 days supply?
Yes, if:
1. the pt has used an initial 30-day supply of the drug or previously been prescribed a 90 day supply
2. the total amount of dispensed does not exceed total amount of prescribed, including refills
3. the prescriber must not have specified a certain method as medically necessary
91
What are the things that can only be done by the pharmacist or a pharmacy intern?
1. Taking new orders over chat or phone
2. identifying, evaulating and interpreting an rx
3. interpreting the clinical data contained in a pts med system or chart
4. consulting with a prescribing practitioner, nurse or HCP
5. dertermining efficacy of a drug, regimen, sub of generic
6. taking responsibility for all activities of pharmaceutical techs
7. counseling pt
8. preforming fuctiosn that require professional judgment of a pharmacist
92
What are acts not required to be done by a pharmacist, inter, tech, or tech in training
1. entering info into pharm compture *execpt info contained in a new rx concerning the rx drug and the directions of use
2. processing sales, including the operation of a cash register
3. stocking shelves
4. delivering meds to a pt or to areas of hospital where pts are cared for
93
when does a pharmacist have to counseling
1. the drug has not been previously dispensed to the pt from that pharmacy or
2. if the professional judgment of the pharmacist or intern thinks it should happen
94
What should be included in the info for counseling
1. name and description of the drug
2. form of dosage, dose, route, and duration
3. intended use of the drug
4. any special directions and precautions
5. any common severe side effects, interactions and contraindications that may occur
6. storage of the drug
7. info about refills
8. actions if you miss a dose
9. any relevant info contained in the record of the med
10. anything the pharmacist feels should be added as professional judgment
95
What is the RPh looking for when they review the pts record before dispensing a RX?
1. overutilization of the drug or drug abuse
2. under utilization of the drug
3. therapeutic duplication
4. interactions between the drug and any *other meds pt is taking, diseases listed, or allergies
5. incorrect dosage or duration of treatment
96
Does a pharmacist always have to counsel a pt?
No, only if the pt or caregiver refuses but it must be documented that the pt refused to accept counseling by a written document or written electronically in the system
*or the rx is a refill and the pt doesn't want it
97
If a practitioner prints out an rx from the electronic system what must they do
Must sign it with a wet signature
98
If an agent of a practitioner transmits an RX to a pharmacy what must the practitioner do
they must review it no later than 24 hours after the transmission
99
what must a prescription transmitted electronically to a pharmacy include
1. the telephone number
2. the time and date of transmission
3. the name of the pharmacy to which the rx is sent
100
what must a electronic transmission of a CS contain?
1. DEA number of prescriber
2. The NV controlled sustance number of the prescriber
3. indication for use or the ICD code
3. date of the last physical examination of the pt
101
When can a C2 be faxed to a pharmacy?
1. when it will be compounded for the direct administration to the pt
2. issuance to a resident of a facility for long-term care
3. patient is enrolled in a program that provides hospice care which has been licensed by this state
102
can a pharmacist refuse to transfer a RX
NO! not in the state of Nevada
103
If the drugs are damaged can the owner of the pharmacy or pharmacist throw them out
No, they must be inspected by the board first before you can throw them out.
104
What is needed in order for an employee to dispense a CS?
request the person who picks up the CS to present a current and valid form of I.D. issued by a federal, state or local governmental agency that contains a photograph of the person
105
An RPh will not fill a rx or dispense a dangerous drug or CS if the rx is:
1. written by practitioner who is lot licensed to practice in the state
2. for a pt who resides in a state other than the state in which the prescribing practice is located
3. requested to be furnished in a manner other than by dispensing directly to the pt, or an agent of the patient, in person
4. to be paid for in full, in cash or cash equivalent, at the time the prescription is dispensed, unless rx is verified
106
What must be done for an RPh to verify an RX?
1. speak with the pt or prescriber
2. establish *rx is real, real relationship between writer and pt
3. record of rx in pharm comp *person you spoke with, date and time, date and time pt was examining by dr
107
what constitutes as a bona fide relationship between the pt and practitioner
1. was physically examined by the practitioner with 6 months preceding the date of the rx was issued
2. the pt is incarcerated and was examined thro use of telephone or video
108
Can a pharmacist fill or refill a prescription that was written by a physician who has since passed away, retired, or moved out of the community or has had their licensed suspended or revoked?
NO!!!
109
The FDA recognizes that a prescription given to a pt by a physician has established a relationship. What happens to the rx once the relationship is severed?
it loses it validity since the physician is no longer available to oversee the use of the drug
110
how many days supply does the Nevada state board feel is reasonable for a interim supply of maintenance meds
they feel that a 30 days supply is reasonable
111
what reasons can a pharmacist decline to fill a rx
use professional judgment to think about
1. filled the rx would be unlawful
2. filled the rx would be imminently harmful to the medical health of the pt
3. the rx is faudulent
4. the rx is not for legit medical use
112
what must happen if the RPh doesnt fill the rx.
1. make effort to speak with prescriber; in the meantime can do:
1. retain the rx and not give to pt
2. return rx to pt
3. make a copy of rx and return rx to pt
4. unless its a C2 give, no more than 3 days worth of med to pt in order to try and reach the dr
113
what happens if the RPh decides that the rx is not lawful
they will retain the rx and not return it to the pt
